Thank you, Deputy Presiding Officer. I do want to acknowledge at the outset the concerns and issues that have been raised by a number of speakers in their contributions, and that lie behind the motion and the proposal, but I do believe that the draft Health and Social Care (Quality and Engagement) (Wales) Bill addresses a number of the points in the motion. Of course, we have just started the scrutiny process on that piece of legislation. I had the opportunity to appear before the Finance Committee today. The passage of that draft Bill through the Assembly will provide an opportunity for these ideas to be debated and discussed, including opportunities for amendments and improvements to be made. Quality is the central concept underpinning the provisions within the Bill. By placing duties at an organisational level, the Bill takes a whole-system approach to quality improvement.

The motion today does include proposals to strengthen the independence of Healthcare Inspectorate Wales. A strong regulator able to act independently of the NHS and Government is an important part of our quality landscape. The arrangements currently in place ensure the inspectorate can and does operate independently. As the health Minister, I am not involved in its oversight or in setting its budget. It is responsible for setting its own programme of work within the broad scope of its remit letter. These are essential factors in ensuring that HIW can and does speak out when it needs to. We do, though, recognise that the existing legislative framework for Healthcare Inspectorate Wales is complicated and does need reform. In the interim, there is a need to incrementally develop HIW's capacity to ensure it is equipped to respond to a future legislative framework. I've made available over £1 million of extra support for the organisation to develop its capacity.

The motion calls for a more transparent system of complaints. We have no evidence of a need to change the 'Putting Things Right' arrangements. A review by Keith Evans found it to be fit for purpose, and his recommendations focused on the need to ensure that the application was consistent. The 'Putting Things Right' arrangements do include the NHS redress scheme, which is innovative and unique within the UK. Claims worth less than £25,000 are dealt with under the scheme, which is far quicker than the litigation process and operates at no cost to complainants.

The Bill that I've referred to will establish a new citizens' voice body and I'm sure there will be lots of opportunities for comment and questioning about that through its passage. That new citizens' voice body will support people or their representatives if they need to make a complaint about health or social care. Additional staff will be funded to enable the new body to extend its services to provide a complaints service, advice and assistance to a wider range of individuals.

The Bill proposes a statutory duty of candour at an organisational level. This will mean that all staff, including managers, will be subject to the duty. There will be training for all staff, at all levels of organisations, whether clinicians or not. And that training will be done in partnership with clinicians. Virtually every professional group within the service is keen to sit down with us, to work on the guidance for the duty of candour, to ensure that it is delivered effectively by individuals and organisations across Wales.

I think perhaps the most important points in the conversation today have been about the challenge of having a blame culture, and the cross between blame and accountability. Now, I recognise that, if we are to deliberately move our healthcare system towards a system more properly based on learning and reflection—if that's not to be an aspiration, but something that is made real—we need to see culture change within organisations. And that applies to clinicians as well as managers. And part of my concern is the language around this potential proposal, which does sound rather more like the ability to get rid of managers, rather than to learn and reflect when things go wrong.

Earlier today, I was at the launch of the maternity vision for Wales. And, again, there, within the maternity profession in Wales, there is real reflection on the things that have gone wrong in different parts of the country—obviously, in the former Cwm Taf area—but there's also real pride in the deliberate choices that they are making, and they are recognised as making within the UK and further afield. And I would not want to see a new system of conduct introduced that moved us away from the ability to learn and reflect. And so, the proposals for a new compulsory regulatory body for NHS managers would introduce a level of cost and complexity, but of course that's always the case when introducing new measures. But we should recall the experiences of nurses in the care homes regulations, when having to attend to two regulators. That did not improve our system, it did not make a difference to those members of staff or the people they're working with or for.

We would need to have detailed finance and policy consideration to reflect the diverse nature of the workforce and their roles, including the point the First Minister made yesterday about defining who or what a manager is to be caught within the ambit of a new regulatory body, whether it is prospective regulation, where everyone must appear on a register to be able to work, or whether it is a retrospective test as to whether someone is a fit-and-proper person. Those are issues that the potential mover of the legislation would need to address, and that balance of responsibility between the employer versus the regulator, and how we ensure that those healthcare professionals, who are the great majority of managers within our system, how they are dealt with, and indeed the mobility of the workforce across borders if we were to introduce this requirement in Wales alone. The British Medical Association, for example, have called in the past for a UK-wide approach to this issue. I'm not persuaded on the case for compulsory regulation for managers, but I'm happy to listen to detailed proposals that address the very real and practical challenges.